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Dai XJ, Liu H, Yang Y, Wang Y, Wan F. Brain network excitatory/inhibitory imbalance is a biomarker for drug-naive Rolandic epilepsy: A radiomics strategy. Epilepsia 2021; 62:2426-2438. [PMID: 34346086 DOI: 10.1111/epi.17011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Seizure occurs when the balance between excitatory and inhibitory (E/I) inputs to neurons is perturbed, resulting in abnormal electrical activity. This study investigated whether an existing E/I imbalance in neural networks is a useful diagnostic biomarker for Rolandic epilepsy by a resting-state dynamic causal modeling-based support vector machine (rs-DCM-SVM) algorithm. METHODS This multicenter study enrolled a discovery cohort (76 children with Rolandic epilepsy and 76 normal controls [NCs]) and a replication cohort (59 children with Rolandic epilepsy and 60 NCs). Spatial independent component analysis was used to seven canonical neural networks, and a total of 25 regions of interest were selected from these networks. The rs-DCM-SVM classifier was used for individual classification, consensus feature selection, and feature ranking. RESULTS The rs-DCM-SVM classifier showed that the E/I imbalance in brain networks is a useful neuroimaging biomarker for Rolandic epilepsy, with an accuracy of 88.2% and 81.5% and an area under curve of .92 and .83 in the discovery and the replication cohorts, respectively. Consensus brain regions with the highest contributions to the classification were located within the epilepsy-related networks, indicating that this classifier was suitable. Consensus functional connection pairs with the highest contributions to the classification were associated with an excitation network loop and an inhibition network loop. The excitation loop mediated the integration of advanced cognitive networks (subcortex, dorsal attention, default mode, executive control, and salience networks), whereas the inhibition loop was involved in the segregation of sensorimotor and language networks. The two loops showed functional segregation. SIGNIFICANCE Brain E/I imbalance has potential to serve as a biomarker for individual classification in children with Rolandic epilepsy, and might be an important mechanism for causing seizures and cognitive impairment in children with Rolandic epilepsy.
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Affiliation(s)
- Xi-Jian Dai
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China.,Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau, China.,Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Yang Yang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Yongjun Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Feng Wan
- Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau, China.,Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau, China
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2
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Dai XJ, Yang Y, Wang N, Tao W, Fan J, Wang Y. Reliability and availability of granger causality density in localization of Rolandic focus in BECTS. Brain Imaging Behav 2021; 15:1542-1552. [PMID: 32737823 DOI: 10.1007/s11682-020-00352-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A new method, called granger causality density (GCD), could reflect the directed information flow of the epileptiform activity, which is much closely match with excitatory and inhibitory imbalance theory of epilepsy. Here, we investigated if GCD could effectively localize the Rolandic focus in 50 patients with benign childhood epilepsy with central-temporal spikes (BECTS) from 27 normal children. The BECTS were classified into ictal epileptiform discharges (IEDs; 12 females, 15 males;age, 8.15 ± 1.68 years) and non-IEDs (10 females, 13 males; age, 9.09 ± 1.98 years) subgroups depending on the presence of central-temporal spikes. Multiple correlation-modality analyses (Pearson, across-voxel and across-subject correlations) were used to calculate the couplings between the GCD maps and IEDs-related brain activation map. The individual lateralization coefficient of localize IEDs and multiple regression analysis were used to identify the reliability of the GCD method in localizing the Rolandic focus. In this study, multiple correlation-modality analyses showed that the IEDs-related brain activation map and the GCD maps had highly temporal (coefficient ׀r\= 0.56 ~ 0.65) and spatial (\r\=0.53~0.91) (r\=~ couplings. The proposed GCD method and multiple regression analyses showed consistent findings with the clinical EEG recordings in lateralization of Rolandic focus. Furthermore, the GCD method could reflect the epilepsy-related brain activity during non-IEDs substate. Therefore, the proposed GCD method has the potential to be served as an effective and reliable neuroimaging biomarker to localize the Rolandic focus of BECTS. These findings are critical for clinical early diagnosis, and may promote the progression of treatment and management of pediatric epilepsy.
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Affiliation(s)
- Xi-Jian Dai
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China.
| | - Yang Yang
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, 563000, China
| | - Na Wang
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China
| | - Weiqun Tao
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China
| | - Jingyi Fan
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China
| | - Yongjun Wang
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, 518003, China.
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3
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Datta AN, Wallbank L, Mak JCH, Wong PKH. Clinical Significance of Incidental Rolandic Spikes in Children With Absence Epilepsy. J Child Neurol 2019; 34:631-638. [PMID: 31113278 DOI: 10.1177/0883073819848639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Absence epilepsy and benign epilepsy of childhood with central temporal spikes are common childhood epilepsy syndromes. Although 3-Hz generalized spike-wave discharges are almost always associated with absence seizures, rolandic spikes can be present in individuals without rolandic seizures. The co-occurrence of 3-Hz generalized spike-wave and rolandic spikes is very rare. Our objective was to compare clinical features of patients with absence epilepsy with and without rolandic spikes, to determine if the additional feature of rolandic spikes has any clinical significance. METHODS Clinical information of 17 children with absence epilepsy and rolandic spikes was compared to an age-matched control group of 90 children with absence epilepsy. RESULTS Although most patients had excellent seizure control at follow-up, epilepsy comorbidities (cognitive and emotional problems) were observed. Comparing study vs control groups, there was no difference with anxiety (2 [11.8%] vs 8 [9%]), behavioral issues (4 [23.5%] vs 10 [11%]), mood disorders (0 vs 2 [2%]), and attention-deficit hyperactivity disorder (4 [24%] vs 10 [11%]). Significant differences were also observed: more global-developmental (5 [29%] vs 5 [6%], P < .009) and expressive-language (4 [24%] vs 5 [6%], P < .034) delay and more difficulties with school performance (11 [65%] vs 32 [36%], P < .025), especially with language-related tasks (6 [35%] vs 5 [6%], P < .001). CONCLUSION Our results confirm the presence of additional epilepsy comorbidities in patients with absence epilepsy when rolandic spikes are present. Rolandic spikes in patients with absence epilepsy may be a marker of additional cognitive challenges that physicians should be aware of.
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Affiliation(s)
- Anita N Datta
- 1 Department of Pediatrics, Division of Neurology, BC Children's Hospital, Vancouver, BC, Canada.,2 Department of Diagnostic Neurophysiology, BC Children's Hospital, BC, Canada
| | - Laura Wallbank
- 2 Department of Diagnostic Neurophysiology, BC Children's Hospital, BC, Canada
| | - Jeremy C H Mak
- 3 Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter K H Wong
- 1 Department of Pediatrics, Division of Neurology, BC Children's Hospital, Vancouver, BC, Canada.,2 Department of Diagnostic Neurophysiology, BC Children's Hospital, BC, Canada
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Coexistence of childhood absence epilepsy and benign epilepsy with centrotemporal spikes: A case series. Eur J Paediatr Neurol 2017; 21:570-575. [PMID: 28238620 DOI: 10.1016/j.ejpn.2017.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/02/2017] [Accepted: 02/05/2017] [Indexed: 12/28/2022]
Abstract
AIM Childhood absence epilepsy (CAE) and benign childhood epilepsy with centrotemporal spikes (BECTS) are the most common forms of childhood epilepsy. Recent studies in animal models suggest that the two phenotypes may represent a neurobiological continuum. Although the coexistence of CAE and BECTS has been reported, this issue remains controversial. The purpose of this study was to analyse the electro-clinical characteristics of a group of children with contemporary or subsequent features of absence seizures and focal seizures consistent with BECTS. MATERIAL AND METHODS A systematic record review from 8 epilepsy centres was used to identify 11 subjects, 5 females and 6 males, with electro-clinical documented consecutive or contemporary coexistence of CAE and BECTS. RESULTS Patient's age ranged between 7.8 and 17.3 years. Four out of 11 patients presented concomitant features of both syndromes, whereas the remaining 7 experienced the two syndromes at different times. CONCLUSIONS Although CAE and BECTS are clearly defined syndromes and considered very different in terms of their pathophysiology, they share some features (such as similar age of onset, overall good prognosis), and can occur in the same patient. The long term prognosis of these patients seems to be good with an excellent response to anticonvulsant therapy.
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Xiong W, Zhou D. Progress in unraveling the genetic etiology of rolandic epilepsy. Seizure 2017; 47:99-104. [PMID: 28351718 DOI: 10.1016/j.seizure.2017.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 02/05/2023] Open
Abstract
Rolandic epilepsy (RE), or benign epilepsy of childhood with centrotemporal spikes (BECT), is the most frequent idiopathic partial epilepsy syndrome of childhood, where the "idiopathic" implies a genetic predisposition. Although RE has long been presumed to have a genetic component, clinical and genetic studies have shown a complex inheritance pattern. Furthermore, the underlying major genetic influence in RE has been challenged by recent reports of twin studies. Meanwhile, many genes or loci have been shown to be associated the RE/atypical RE (ARE) spectrum, with a higher frequency of causative variants in ARE. However, a full understanding of the genetic basis in the more common forms of the RE spectrum remains elusive.
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Affiliation(s)
- Weixi Xiong
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Turner SJ, Morgan AT, Perez ER, Scheffer IE. New genes for focal epilepsies with speech and language disorders. Curr Neurol Neurosci Rep 2016; 15:35. [PMID: 25921602 DOI: 10.1007/s11910-015-0554-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The last 2 years have seen exciting advances in the genetics of Landau-Kleffner syndrome and related disorders, encompassed within the epilepsy-aphasia spectrum (EAS). The striking finding of mutations in the N-methyl-D-aspartate (NMDA) receptor subunit gene GRIN2A as the first monogenic cause in up to 20% of patients with EAS suggests that excitatory glutamate receptors play a key role in these disorders. Patients with GRIN2A mutations have a recognizable speech and language phenotype that may assist with diagnosis. Other molecules involved in RNA binding and cell adhesion have been implicated in EAS; copy number variations are also found. The emerging picture highlights the overlap between the genetic determinants of EAS with speech and language disorders, intellectual disability, autism spectrum disorders and more complex developmental phenotypes.
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Affiliation(s)
- Samantha J Turner
- Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Australia,
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8
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Smith AB, Bajomo O, Pal DK. A meta-analysis of literacy and language in children with rolandic epilepsy. Dev Med Child Neurol 2015. [PMID: 26219529 DOI: 10.1111/dmcn.12856] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Rolandic epilepsy is the most common childhood epilepsy, often presenting with neuropsychological impairments. The aim of the study was to formally assimilate the findings of existing studies varying widely in methodology, thereby confirming the nature and prevalence of impairments in literacy and language. METHODS Using meta-analytical techniques, we evaluated 22 studies of literacy and/or language skills in children with rolandic epilepsy, published after 2000, among participants with IQs>70 and in which effect sizes could be acquired. Diagnosis required the presence of classical centrotemporal spikes arising from a normal background on electroencephalograms; a clinical history including at least one seizure; and no additional neurological condition. Overall effect size and heterogeneity were measured for single-word reading, phonological processing, and expressive and receptive language. RESULTS Mean effect sizes (Cohen's d) ranged from 0.50 (95% confidence interval [CI] 0.23-0.78) for phonological processing, through 0.71 (95% CI 0.52-0.90) for word reading and 0.72 (95% CI 0.34-1.1) for receptive language, to 0.75 (95% CI 0.45-1.05) for expressive language. While group differences for reading measures were consistent, those for language were heterogeneous and varied across studies explained by age and IQ of samples. INTERPRETATION The presence of reading and phonological processing deficits in children with rolandic epilepsy highlights the importance of early literacy and language assessment in this population.
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Affiliation(s)
- Anna B Smith
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Omotomilola Bajomo
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Deb K Pal
- Department of Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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9
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Vannest J, Tenney JR, Gelineau-Morel R, Maloney T, Glauser TA. Cognitive and behavioral outcomes in benign childhood epilepsy with centrotemporal spikes. Epilepsy Behav 2015; 45:85-91. [PMID: 25775975 DOI: 10.1016/j.yebeh.2015.01.041] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 01/10/2023]
Abstract
We review the evidence that BECTS may be associated with cognitive dysfunction and behavioral problems, the extent to which these problems may be associated with patterns of EEG abnormalities in BECTS, and the impact of antiepileptic medication on cognition and behavior in BECTS. A growing literature examining cognitive and behavioral outcomes suggests that children with BECTS perform below the level of their peers. Consistent with this, neuroimaging studies reveal that BECTS has an impact on structural and functional brain development, but the potential influence of frequency and lateralization of centrotemporal spikes (CTS) on cognition and behavior is not well understood. Treatment with AEDs is an option in BECTS, but existing studies have not clearly shown a clear relationship between elimination of CTS and improved cognitive or behavioral outcomes.
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10
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Gkampeta A, Fidani L, Clarimón J, Kalinderi K, Katopodi T, Zafeiriou D, Pavlou E. Association of brain-derived neurotrophic factor (BDNF) and elongator protein complex 4 (ELP4) polymorphisms with benign epilepsy with centrotemporal spikes in a Greek population. Epilepsy Res 2014; 108:1734-9. [PMID: 25301525 DOI: 10.1016/j.eplepsyres.2014.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/02/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Benign epilepsy with centrotemporal spikes (BECTS) is considered to be the most common childhood epileptic syndrome. Different mutations in genes that control the excitability of neurons have been described. Recent reports on the involvement of the BDNF and ELP4 genes in cell motility, migration, and adhesion raise the possibility that these genes are involved in pathogenesis of BECTS. MATERIALS AND METHODS We conducted a case-control association study on 60 patients with BECTS and 60 control participants to assess the influence of the BDNF and ELP4 polymorphisms on BECTS. The polymorphisms were detected with a PCR-RFLP method. Moreover, we explored the possible association of these polymorphisms with clinical and electroencephalographic parameters of patients with BECTS. RESULTS Our results show no difference in BDNF and ELP4 genotype frequencies between patients and controls. Haplotype analysis also revealed no statistical difference. CONCLUSION The role of BDNF and ELP4 polymorphisms remains controversial.
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Affiliation(s)
- Anastasia Gkampeta
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, 'AHEPA' General Hospital, Thessaloniki, Greece.
| | - Liana Fidani
- Department of General Biology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jordi Clarimón
- Memory Unit, Alzheimer's Laboratory, and Centro de Investigación Biomédica en Red (CIBERNED), Neurology Department, Sant Pau Hospital, Barcelona, Spain
| | - Kallirhoe Kalinderi
- Department of General Biology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Teodora Katopodi
- Department of General Biology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Pavlou
- 2nd Department of Pediatrics, Aristotle University of Thessaloniki, 'AHEPA' General Hospital, Thessaloniki, Greece
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Changes in current-source density of interictal spikes in benign epilepsy of childhood with centrotemporal spikes following treatment with oxcarbazepine. Seizure 2014; 23:560-6. [DOI: 10.1016/j.seizure.2014.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/09/2014] [Accepted: 04/11/2014] [Indexed: 11/17/2022] Open
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12
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Reinthaler EM, Lal D, Lebon S, Hildebrand MS, Dahl HHM, Regan BM, Feucht M, Steinböck H, Neophytou B, Ronen GM, Roche L, Gruber-Sedlmayr U, Geldner J, Haberlandt E, Hoffmann P, Herms S, Gieger C, Waldenberger M, Franke A, Wittig M, Schoch S, Becker AJ, Hahn A, Männik K, Toliat MR, Winterer G, Lerche H, Nürnberg P, Mefford H, Scheffer IE, Berkovic SF, Beckmann JS, Sander T, Jacquemont S, Reymond A, Zimprich F, Neubauer BA. 16p11.2 600 kb Duplications confer risk for typical and atypical Rolandic epilepsy. Hum Mol Genet 2014; 23:6069-80. [PMID: 24939913 DOI: 10.1093/hmg/ddu306] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rolandic epilepsy (RE) is the most common idiopathic focal childhood epilepsy. Its molecular basis is largely unknown and a complex genetic etiology is assumed in the majority of affected individuals. The present study tested whether six large recurrent copy number variants at 1q21, 15q11.2, 15q13.3, 16p11.2, 16p13.11 and 22q11.2 previously associated with neurodevelopmental disorders also increase risk of RE. Our association analyses revealed a significant excess of the 600 kb genomic duplication at the 16p11.2 locus (chr16: 29.5-30.1 Mb) in 393 unrelated patients with typical (n = 339) and atypical (ARE; n = 54) RE compared with the prevalence in 65,046 European population controls (5/393 cases versus 32/65,046 controls; Fisher's exact test P = 2.83 × 10(-6), odds ratio = 26.2, 95% confidence interval: 7.9-68.2). In contrast, the 16p11.2 duplication was not detected in 1738 European epilepsy patients with either temporal lobe epilepsy (n = 330) and genetic generalized epilepsies (n = 1408), suggesting a selective enrichment of the 16p11.2 duplication in idiopathic focal childhood epilepsies (Fisher's exact test P = 2.1 × 10(-4)). In a subsequent screen among children carrying the 16p11.2 600 kb rearrangement we identified three patients with RE-spectrum epilepsies in 117 duplication carriers (2.6%) but none in 202 carriers of the reciprocal deletion. Our results suggest that the 16p11.2 duplication represents a significant genetic risk factor for typical and atypical RE.
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Affiliation(s)
| | - Dennis Lal
- Cologne Center for Genomics, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany, Department of Neuropediatrics, University Medical Faculty Giessen and Marburg, Giessen, Germany
| | - Sebastien Lebon
- Unit of Pediatric Neurology and Neurorehabilitation, Department of Pediatrics
| | - Michael S Hildebrand
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Hans-Henrik M Dahl
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Brigid M Regan
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Martha Feucht
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Birgit Neophytou
- Department of Neuropediatrics, St. Anna Children's Hospital, Vienna, Austria
| | - Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Laurian Roche
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Julia Geldner
- Department of Pediatrics, Hospital SMZ Süd Kaiser-Franz-Josef Spital, Vienna, Austria
| | - Edda Haberlandt
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany, Division of Medical Genetics, University Hospital and Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Stefan Herms
- Institute of Human Genetics, University of Bonn, Bonn, Germany, Division of Medical Genetics, University Hospital and Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Christian Gieger
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Genetic Epidemiology, Neuherberg, Germany
| | - Melanie Waldenberger
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Michael Wittig
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Susanne Schoch
- Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Albert J Becker
- Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Andreas Hahn
- Department of Neuropediatrics, University Medical Faculty Giessen and Marburg, Giessen, Germany
| | - Katrin Männik
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland, Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | | | - Georg Winterer
- Experimental and Clinical Research Center (ECRC) Charité, University Medicine Berlin, Berlin, Germany
| | | | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Heather Mefford
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Ingrid E Scheffer
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia, Florey Institute and Department of Pediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Jacques S Beckmann
- Service of Medical Genetics, Lausanne University Hospital, Lausanne, Switzerland, Swiss Institute of Bioinformatics, Lausanne, Switzerland and
| | | | | | | | - Sebastien Jacquemont
- Service of Medical Genetics, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandre Reymond
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | | | - Bernd A Neubauer
- Department of Neuropediatrics, University Medical Faculty Giessen and Marburg, Giessen, Germany
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Paolicchi JM. The timing of pediatric epilepsy syndromes: what are the developmental triggers? Ann N Y Acad Sci 2014; 1304:45-51. [PMID: 24279892 DOI: 10.1111/nyas.12307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pediatric epilepsy is characterized by multiple epilepsy syndromes with specific developmental triggers. They initiate spontaneously at critical periods of development and can just as spontaneously remit. Accompanying neurocognitive disabilities are often specific to the epileptic syndrome. Infantile or epileptic spasms have a very specific developmental window in the first year of life. Preceding the epilepsy, developmental arrest is common. The neurologic pathways underlying the development of spasms have been identified through PET scans as developmental abnormalities of serotonergic and GABAergic neurotransmitter systems in the brain stem and basal ganglia. Childhood absence epilepsy (CAE) and benign centrotemporal epilepsy syndrome (BECTS) are both known genetic epilepsy syndromes; they have a discrete onset in childhood with remission by puberty. In CAE, disturbances of specific calcium channels at key developmental stages lead to aberrant disruption of thalamocortical synchrony. Similarly, a complex interplay between brain development, maturation, and susceptibility genes underlies the seizures and the neurocognitive deficits of BECTS.
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van Passel L, Arif H, Hirsch LJ. Topiramate for the treatment of epilepsy and other nervous system disorders. Expert Rev Neurother 2014; 6:19-31. [PMID: 16466308 DOI: 10.1586/14737175.6.1.19] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Initially synthesized as an oral hypoglycemic agent, topiramate was approved for use as an anticonvulsant in 1996. Its broad spectrum efficacy in epilepsy, including as monotherapy and in children, is well established. Topiramate has also been used in the management of nonepileptic neurologic and psychiatric conditions, including migraine prophylaxis (with firmly established efficacy), obesity (with some evidence of long-term maintenance of weight loss), substance dependence, bipolar disorder and neuropathic pain, and it has been investigated as a possible neuroprotective agent. Paresthesias and cognitive side effects are the most common troublesome adverse effects. Recent trends towards lower doses may help achieve the best combination of efficacy and tolerability.
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Affiliation(s)
- Leonie van Passel
- Comprehensive Epilepsy Center, Neurological Institute, Columbia University, Box NI-135, New York, NY 10032, USA.
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15
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Lal D, Reinthaler EM, Altmüller J, Toliat MR, Thiele H, Nürnberg P, Lerche H, Hahn A, Møller RS, Muhle H, Sander T, Zimprich F, Neubauer BA. RBFOX1 and RBFOX3 mutations in rolandic epilepsy. PLoS One 2013; 8:e73323. [PMID: 24039908 PMCID: PMC3765197 DOI: 10.1371/journal.pone.0073323] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/19/2013] [Indexed: 12/20/2022] Open
Abstract
Partial deletions of the gene encoding the neuronal splicing regulator RBFOX1 have been reported in a range of neurodevelopmental diseases, including idiopathic generalized epilepsy. The RBFOX1 protein and its homologues (RBFOX2 and RBFOX3) regulate alternative splicing of many neuronal transcripts involved in the homeostatic control of neuronal excitability. In this study, we explored if structural microdeletions and exonic sequence variations in RBFOX1, RBFOX2, RBFOX3 confer susceptibility to rolandic epilepsy (RE), a common idiopathic focal childhood epilepsy. By high-density SNP array screening of 289 unrelated RE patients, we identified two hemizygous deletions, a 365 kb deletion affecting two untranslated 5′-terminal exons of RBFOX1 and a 43 kb deletion spanning exon 3 of RBFOX3. Exome sequencing of 242 RE patients revealed two novel probably deleterious variants in RBFOX1, a frameshift mutation (p.A233Vfs*74) and a hexanucleotide deletion (p.A299_A300del), and a novel nonsense mutation in RBFOX3 (p.Y287*). Although the three variants were inherited from unaffected parents, they were present in all family members exhibiting the RE trait clinically or electroencephalographically with only one exception. In contrast, no deleterious mutations of RBFOX1 and RBFOX3 were found in the exomes of 6503 non-RE subjects deposited in the Exome Variant Server database. The observed RBFOX3 exon 3 deletion and nonsense mutation suggest that RBFOX3 represents a novel risk factor for RE, indicating that exon deletions and truncating mutations of RBFOX1 and RBFOX3 contribute to the genetic variance of partial and generalized idiopathic epilepsy syndromes.
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Affiliation(s)
- Dennis Lal
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Department of Neuropediatrics, University Medical Clinic Giessen, Giessen, Germany
| | - Eva M. Reinthaler
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Janine Altmüller
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | | | - Holger Thiele
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Andreas Hahn
- Department of Neuropediatrics, University Medical Clinic Giessen, Giessen, Germany
| | | | - Hiltrud Muhle
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany
| | - Thomas Sander
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Bernd A. Neubauer
- Department of Neuropediatrics, University Medical Clinic Giessen, Giessen, Germany
- * E-mail:
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Epileptic syndromes with focal seizures of childhood and adolescence. HANDBOOK OF CLINICAL NEUROLOGY 2012. [PMID: 22938972 DOI: 10.1016/b978-0-444-52898-8.00012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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17
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Emerging genetic influences in benign epilepsy with centro-temporal spikes - BECTS. Epilepsy Res 2012; 101:197-201. [PMID: 22818593 DOI: 10.1016/j.eplepsyres.2012.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 06/06/2012] [Accepted: 06/30/2012] [Indexed: 02/06/2023]
Abstract
BECTS is considered to be the most common childhood epileptic syndrome. Multifactorial inheritance is the most important model accounting for the genetic behavior of the common epilepsies. In recent years, different mutations in genes that control the excitability of neurons have been described. Recent reports on the involvement of the BDNF and ELP4 genes with possible roles in cell motility, migration, and adhesion have provided first insights into the complex molecular bases of childhood focal epilepsies. However, in the most common idiopathic benign childhood epilepsies (BECTS and occipital epilepsies), major breakthroughs are still awaited.
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Vears DF, Tsai MH, Sadleir LG, Grinton BE, Lillywhite LM, Carney PW, Simon Harvey A, Berkovic SF, Scheffer IE. Clinical genetic studies in benign childhood epilepsy with centrotemporal spikes. Epilepsia 2012; 53:319-24. [DOI: 10.1111/j.1528-1167.2011.03368.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Cerminara C, Coniglio A, El-Malhany N, Casarelli L, Curatolo P. Two epileptic syndromes, one brain: childhood absence epilepsy and benign childhood epilepsy with centrotemporal spikes. Seizure 2011; 21:70-4. [PMID: 22000044 DOI: 10.1016/j.seizure.2011.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 09/15/2011] [Accepted: 09/15/2011] [Indexed: 01/31/2023] Open
Abstract
Childhood absence epilepsy (CAE) and benign childhood epilepsy with centrotemporal spikes (BCECTS), or benign rolandic epilepsy (BRE), are the most common forms of childhood epilepsy. CAE and BCECTS are well-known and clearly defined syndromes; although they are strongly dissimilar in terms of their pathophysiology, these functional epileptic disturbances share many features such as similar age at onset, overall good prognosis, and inheritance factors. Few reports are available on the concomitance of CAE and BCECTS in the same patients or the later occurrence of generalized epilepsy in patients with a history of partial epilepsy. In most cases described in the literature, absence seizures always started after the onset of benign focal epilepsy but the contrary has never occurred yet. We describe two patients affected by idiopathic generalized epileptic syndrome with typical absences, who experienced BCECTS after remission of seizures and normalization of EEG recordings. While the coexistence of different seizure types within an epileptic syndrome is not uncommon, the occurrence of childhood absence and BCECTS in the same child appears to be extremely rare, and this extraordinary event supports the hypothesis that CAE and BCECTS are two distinct epileptic conditions. However, recent interesting observations in animal models suggest that BCECTS and CAE could be pathophysiologically related and that genetic links could play a large role.
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Affiliation(s)
- Caterina Cerminara
- Department of Neuroscience, Pediatric Neurology Unit, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy.
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20
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Rejnö-Habte Selassie G, Hedström A, Viggedal G, Jennische M, Kyllerman M. Speech, language, and cognitive dysfunction in children with focal epileptiform activity: A follow-up study. Epilepsy Behav 2010; 18:267-75. [PMID: 20493782 DOI: 10.1016/j.yebeh.2010.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/16/2010] [Accepted: 04/13/2010] [Indexed: 11/27/2022]
Abstract
We reviewed the medical history, EEG recordings, and developmental milestones of 19 children with speech and language dysfunction and focal epileptiform activity. Speech, language, and neuropsychological assessments and EEG recordings were performed at follow-up, and prognostic indicators were analyzed. Three patterns of language development were observed: late start and slow development, late start and deterioration/regression, and normal start and later regression/deterioration. No differences in test results among these groups were seen, indicating a spectrum of related conditions including Landau-Kleffner syndrome and epileptic language disorder. More than half of the participants had speech and language dysfunction at follow-up. IQ levels, working memory, and processing speed were also affected. Dysfunction of auditory perception in noise was found in more than half of the participants, and dysfunction of auditory attention in all. Dysfunction of communication, oral motor ability, and stuttering were noted in a few. Family history of seizures and abundant epileptiform activity indicated a worse prognosis.
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Affiliation(s)
- Gunilla Rejnö-Habte Selassie
- Institute of Neuroscience and Physiology/Speech and Language Pathology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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Rudolf G, Valenti MP, Hirsch E, Szepetowski P. From rolandic epilepsy to continuous spike-and-waves during sleep and Landau-Kleffner syndromes: insights into possible genetic factors. Epilepsia 2009; 50 Suppl 7:25-8. [PMID: 19682046 DOI: 10.1111/j.1528-1167.2009.02214.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Epilepsy is a frequent neurologic disease in childhood, characterized by recurrent seizures and sometimes with major effects on social, behavioral, and cognitive development. Childhood focal epilepsies particularly are age-related diseases mainly occurring during developmental critical periods. A complex interplay between brain development and maturation processes and susceptibility genes may contribute to the development of various childhood epileptic syndromes associated with language and cognitive deficits. Indeed, the Landau-Kleffner syndrome (LKS), the continuous spike-and-waves during sleep syndrome (CSWS), and the benign childhood epilepsy with centrotemporal spikes (BCECTS) or benign rolandic epilepsy, are different entities that are considered as part of a single continuous spectrum of disorders. Genetic predisposition with simple to complex modes of inheritance has long been suspected for this wide group of childhood focal epilepsies. Recent reports on the involvement of the SRPX2 and ELP4 genes with possible roles in cell motility, migration, and adhesion have provided first insights into the complex molecular bases of childhood focal epilepsies.
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Affiliation(s)
- Gabrielle Rudolf
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital BP 426, Strasbourg cedex, France.
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22
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Sodium and potassium channel dysfunctions in rare and common idiopathic epilepsy syndromes. Brain Dev 2009; 31:515-20. [PMID: 19464834 DOI: 10.1016/j.braindev.2009.04.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 04/20/2009] [Indexed: 11/21/2022]
Abstract
Mutations in the SCN1A gene are found in up to 80% of individuals with severe myoclonic epilepsy of infancy (SMEI), and mutations in KCNQ2 and KCNQ3 were identified in benign familial neonatal convulsions (BFNC) as well as in single families with Rolandic epilepsy (RE) and idiopathic generalized epilepsies (IGE). This paper summarizes recent findings concerning sodium (SCN1A) and potassium channel (KCNQ2 and KCNQ3) dysfunctions in the pathogenesis of rare and common idiopathic epilepsies (IE). SMEI, severe idiopathic generalized epilepsy of infancy (SIGEI), and myoclonic-astatic epilepsy (MAE) are rare IE. Because of some semeiologic overlap, a comparative analysis of the SCN1A gene performed in 20 patients with MAE and in 18 with SIGEI. This revealed mutations in three subjects with SIGEI only. Since BFNC are over-represented in families with RE, a mutational analysis was performed in 58 families with RE with and without BNFC. This revealed functionally relevant mutations in two index cases with BNFC, and three missense mutations (one resulting in a significantly reduced potassium current amplitude) in three patients with RE, but without BNFC. One KCNQ3 missense variant was also detected in eight out of 455 IGE patients but not in 454 controls, and a silent KCNQ2-SNP was found over-represented in both epilepsy samples. These findings confirm that mutations in the SCN1A gene are mainly involved in the pathogenesis of SMEI, rarely in that of SIGEI, and are commonly not found in patients with MAE. They also demonstrate that sequence variations of the KCNQ2 and KCNQ3 genes may contribute to the etiology of common IE syndromes.
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Hirano Y, Oguni H, Funatsuka M, Imai K, Osawa M. Neurobehavioral abnormalities may correlate with increased seizure burden in children with Panayiotopoulos syndrome. Pediatr Neurol 2009; 40:443-8. [PMID: 19433278 DOI: 10.1016/j.pediatrneurol.2008.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 12/10/2008] [Accepted: 12/15/2008] [Indexed: 10/20/2022]
Abstract
Prognostic factors for frequent seizure recurrences were studied in patients with Panayiotopoulos syndrome. The subjects were 79 children fulfilling the criteria of Panayiotopoulos syndrome who were monitored for longer than 2 years. Medical records and electroencephalograms were analyzed retrospectively. The total number of seizures in each patient at the final follow-up ranged from 1 to 22. The 79 patients were classified into three groups: typical Panayiotopoulos syndrome (seizure recurrence = 1-5 times, n = 45), borderline (6-9 times, n = 16), and atypical (>10 times, n = 18). Data analyzed included family history of seizure disorders, peri- and postnatal complications, previous seizure histories, age at epilepsy onset, clinical seizure manifestations, the frequency of status epilepticus, interictal electroencephalographic patterns, and the possible association of neurobehavioral disorders among the three groups. An association with pre-existing neurobehavioral disorders was significantly more frequent in the atypical than in the typical group (P < 0.05), but not significantly different between the typical and borderline or between the borderline and atypical patients (P> 0.05). In patients with Panayiotopoulos syndrome and pre-existing mild neurobehavioral disorders, seizures tend to be pharmacoresistant and to repeat more than 10 times. However, all patients experience seizure remission by 12 years of age, and should not be evaluated for surgery.
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Affiliation(s)
- Yoshiko Hirano
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
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24
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Hemodynamic changes preceding the interictal EEG spike in patients with focal epilepsy investigated using simultaneous EEG-fMRI. Neuroimage 2009; 45:1220-31. [DOI: 10.1016/j.neuroimage.2009.01.014] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Revised: 01/05/2009] [Accepted: 01/08/2009] [Indexed: 11/24/2022] Open
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Panayiotopoulos CP, Michael M, Sanders S, Valeta T, Koutroumanidis M. Benign childhood focal epilepsies: assessment of established and newly recognized syndromes. Brain 2008; 131:2264-86. [DOI: 10.1093/brain/awn162] [Citation(s) in RCA: 277] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Durá Travé T, Yoldi Petri M, Gallinas Victoriano F, García de Gurtuba I, Gallizo. Epilepsia rolándica: características epidemiológicas, clínicas y evolutivas. An Pediatr (Barc) 2008; 68:466-73. [DOI: 10.1157/13120044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bali B, Kull LL, Strug LJ, Clarke T, Murphy PL, Akman CI, Greenberg DA, Pal DK. Autosomal dominant inheritance of centrotemporal sharp waves in rolandic epilepsy families. Epilepsia 2007; 48:2266-72. [PMID: 17662063 PMCID: PMC2150739 DOI: 10.1111/j.1528-1167.2007.01221.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Centrotemporal sharp (CTS) waves, the electroencephalogram (EEG) hallmark of rolandic epilepsy, are found in approximately 4% of the childhood population. The inheritance of CTS is presumed autosomal dominant but this is controversial. Previous studies have varied considerably in methodology, especially in the control of bias and confounding. We aimed to test the hypothesis of autosomal dominant inheritance of CTS in a well-designed family segregation analysis study. METHODS Probands with rolandic epilepsy were collected through unambiguous single ascertainment. Siblings in the age range 4-16 years underwent sleep-deprived EEG; observations from those who remained awake were omitted. CTS were rated as present or absent by two independent observers blinded to the study hypothesis and subject identities. We computed the segregation ratio of CTS, corrected for ascertainment. We tested the segregation ratio estimate for consistency with dominant and recessive modes of inheritance, and compared the observed sex ratio of those affected with CTS for consistency with sex linkage. RESULTS Thirty siblings from 23 families underwent EEG examination. Twenty-three showed evidence of sleep in their EEG recordings. Eleven of 23 recordings demonstrated CTS, yielding a corrected segregation ratio of 0.48 (95% CI: 0.27-0.69). The male to female ratio of CTS affectedness was approximately equal. CONCLUSIONS The segregation ratio of CTS in rolandic epilepsy families is consistent with a highly penetrant autosomal dominant inheritance, with equal sex ratio. Autosomal recessive and X-linked inheritance are rejected. The CTS locus might act in combination with one or more loci to produce the phenotype of rolandic epilepsy.
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Affiliation(s)
- Bhavna Bali
- Department of Epidemiology, Columbia University, New York, New York, U.S.A
| | - Lewis L. Kull
- Department of Neurology, Columbia University, New York, New York, U.S.A
| | - Lisa J. Strug
- Department of Division of Statistical Genetics, Columbia University, New York, New York, U.S.A
| | - Tara Clarke
- Department of Epidemiology, Columbia University, New York, New York, U.S.A
| | | | - Cigdem I. Akman
- Department of Neurology, Columbia University, New York, New York, U.S.A
| | - David A. Greenberg
- Department of Psychiatry, Columbia University, New York, New York, U.S.A
- Department of Division of Statistical Genetics, Columbia University, New York, New York, U.S.A
| | - Deb K. Pal
- Department of Epidemiology, Columbia University, New York, New York, U.S.A
- Department of Psychiatry, Columbia University, New York, New York, U.S.A
- Department of Division of Statistical Genetics, Columbia University, New York, New York, U.S.A
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Boor R, Jacobs J, Hinzmann A, Bauermann T, Scherg M, Boor S, Vucurevic G, Pfleiderer C, Kutschke G, Stoeter P. Combined spike-related functional MRI and multiple source analysis in the non-invasive spike localization of benign rolandic epilepsy. Clin Neurophysiol 2007; 118:901-9. [PMID: 17317297 DOI: 10.1016/j.clinph.2006.11.272] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Revised: 10/30/2006] [Accepted: 11/08/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To localize the irritative zone in children by combined spike-related fMRI and EEG multiple source analysis (MSA) in children with benign rolandic epilepsy. METHODS Interictal spikes were averaged and localized using MSA, and source locations were displayed in the anatomical 3D-MRI in 11 patients (5-12 yrs, median 10). Interictal spikes were additionally recorded during the fMRI acquisition (EEG-fMRI), and the fMRI sequences were correlated off-line with the EEG spikes. RESULTS MSA revealed an initial central dipole in all patients, including the face or hand area. A second dipolar source was mostly consistent with propagated activity. BOLD activations from EEG-fMRI, consistent with the locations of the initial dipoles, were found in four patients. We found additional large areas of BOLD activations in 3 of these subjects extending into the sylvian fissure and the insula. These were identified as propagated activity by MSA using the short time differences in the source waveforms. CONCLUSIONS MSA provided reliable localization of the spike onset zone in all children with benign rolandic epilepsy. Using the combination of EEG-fMRI and MSA we were able to discriminate the spike onset zone from propagated epileptiform source activity, using the spatial resolution of the EEG-fMRI technique and the temporal resolution of the MSA. However, the sensitivity of the EEG-fMRI technique was low and further improvements of the technique are warranted. SIGNIFICANCE This study shows that a combination of EEG-fMRI and MSA may be a powerful tool to describe the irritative zone of patients with idiopathic focal epilepsies. Clinical studies in patients with non-idiopathic focal epilepsies may clarify whether both techniques can be used as complementary clinical tools to localize the onset of interictal epileptic activity in focal epilepsies.
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Affiliation(s)
- R Boor
- University Children's Hospital, Pediatric Neurology Johannes-Gutenberg University, Mainz, Germany.
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De Tiège X, Goldman S, Verheulpen D, Aeby A, Poznanski N, Van Bogaert P. Coexistence of Idiopathic Rolandic Epilepsy and CSWS in Two Families. Epilepsia 2006; 47:1723-7. [PMID: 17054694 DOI: 10.1111/j.1528-1167.2006.00644.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To report two families combining benign childhood epilepsy with centrotemporal spikes (BCECS) and cryptogenic epilepsy with continuous spike-waves during sleep (CSWS) in first-degree relatives. METHODS Clinical, EEG, and cerebral imaging data are described. RESULTS FAMILY 1: The proband was 3 years old at epilepsy onset. First seizures were convulsive, with centrotemporal spikes on EEG. At age 5 years, he had complex partial seizures, psychomotor regression, and centrotemporal CSWS. [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) showed left parietal hypermetabolism. After several antiepileptic drug (AED) trials, valproate (VPA) and ethosuximide (ESM) induced seizure remission, CSWS disappearance, and psychomotor improvement. Learning disabilities, however, persisted. Family history was remarkable for BCECS in his father. FAMILY 2: The proband was 2 years old at epilepsy onset. First seizures were convulsive, with centrotemporal CSWS on EEG. Despite several AED trials including corticosteroids, focal negative myoclonia, atypical absences, and psychomotor regression occurred, leading to severe mental retardation. FDG-PET showed bilateral parietal hypermetabolism. Vagus nerve stimulator was implanted. Her family history was remarkable for BCECS in her father and febrile convulsions in infancy in her mother. CONCLUSIONS These data suggest the existence of a common genetic basis between BCECS and cryptogenic epilepsies with CSWS. The higher expression in patients with CSWS could be related to other genetic or acquired factors. These data suggest that these epileptic syndromes constitute edges of a continuum.
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Affiliation(s)
- Xavier De Tiège
- Department of Pediatric Neurology, ULB-Hôspital Erasme, Université Libre de Brussels, Brussles, Belgium.
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Vadlamudi L, Kjeldsen MJ, Corey LA, Solaas MH, Friis ML, Pellock JM, Nakken KO, Milne RL, Scheffer IE, Harvey AS, Hopper JL, Berkovic SF. Analyzing the etiology of benign rolandic epilepsy: a multicenter twin collaboration. Epilepsia 2006; 47:550-5. [PMID: 16529620 DOI: 10.1111/j.1528-1167.2006.00466.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Benign rolandic epilepsy (BRE) is considered a genetically determined idiopathic partial epilepsy. We analyzed a large sample of twins from four international twin registers to probe the genetics of BRE. We also aim to synthesize the apparently conflicting family and twin data into a model of BRE etiology. METHODS Large population-based twin registries of epilepsies from Odense (Denmark), Richmond, Virginia (United States), and Oslo (Norway) were reviewed for BRE cases and added to our Australian twin data. Diagnosis of classic BRE was based on electroclinical criteria with normal neurologic development. Cases with a compatible electroclinical picture but abnormal neurologic development were termed non-classic BRE. RESULTS Eighteen twin pairs were identified (10 monozygous; eight dizygous) of whom at least one twin was diagnosed with classic BRE among a total sample of 1,952 twin pairs validated for seizures, and all were discordant for BRE. The estimated monozygous pairwise concordance for BRE in this sample was 0.0 [95% confidence interval (CI), 0.0-0.3). Four twin pairs (one monozygous, three dizygous) had non-classic BRE, and all co-twins had seizures. CONCLUSIONS The twin data showing an absence of any concordant twin pairs with classic BRE suggest that noninherited factors are of major importance in BRE. Modelling the data shows that the familial occurrence of centrotemporal spikes makes only a minor contribution to the familial aggregation of BRE. Genetic factors are probably more important in non-classic BRE. The etiology and mode(s) of inheritance of BRE are much more complicated than initially conceptualized.
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Affiliation(s)
- Lata Vadlamudi
- Epilepsy Research Centre, Department of Medicine (Neurology), University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
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Vadlamudi L, Harvey AS, Hopper JL, Scheffer IE, Berkovic SF. Reply. Ann Neurol 2005. [DOI: 10.1002/ana.20398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Marini C, Scheffer IE, Crossland KM, Grinton BE, Phillips FL, McMahon JM, Turner SJ, Dean JT, Kivity S, Mazarib A, Neufeld MY, Korczyn AD, Harkin LA, Dibbens LM, Wallace RH, Mulley JC, Berkovic SF. Genetic Architecture of Idiopathic Generalized Epilepsy: Clinical Genetic Analysis of 55 Multiplex Families. Epilepsia 2004; 45:467-78. [PMID: 15101828 DOI: 10.1111/j.0013-9580.2004.46803.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE In families with idiopathic generalized epilepsy (IGE), multiple IGE subsyndromes may occur. We performed a genetic study of IGE families to clarify the genetic relation of the IGE subsyndromes and to improve understanding of the mode(s) of inheritance. METHODS Clinical and genealogic data were obtained on probands with IGE and family members with a history of seizures. Families were grouped according to the probands' IGE subsyndrome: childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and IGE with tonic-clonic seizures only (IGE-TCS). The subsyndromes in the relatives were analyzed. Mutations in genes encoding alpha1 and gamma 2 gamma-aminobutyric acid (GABA)-receptor subunits, alpha1 and beta1 sodium channel subunits, and the chloride channel CLC-2 were sought. RESULTS Fifty-five families were studied. 122 (13%) of 937 first- and second-degree relatives had seizures. Phenotypic concordance within families of CAE and JME probands was 28 and 27%, respectively. JAE and IGE-TCS families had a much lower concordance (10 and 13%), and in the JAE group, 31% of relatives had CAE. JME was rare among affected relatives of CAE and JAE probands and vice versa. Mothers were more frequently affected than fathers. No GABA-receptor or sodium or chloride channel gene mutations were identified. CONCLUSIONS The clinical genetic analysis of this set of families suggests that CAE and JAE share a close genetic relation, whereas JME is a more distinct entity. Febrile seizures and epilepsy with unclassified tonic-clonic seizures were frequent in affected relatives of all IGE individuals, perhaps representing a nonspecific susceptibility to seizures. A maternal effect also was seen. Our findings are consistent with an oligogenic model of inheritance.
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Affiliation(s)
- Carla Marini
- Epilepsy Research Institute, Department of Medicine (Neurology) The University of Melbourne, Austin Health, Victoria, Australia
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Holtmann M, Becker K, el-Faddagh M, Schmidt MH. Benigne epilepsietypische Potentiale des Kindesalters (Rolando-Spikes) - neurobiologische und neuropsychologische Befunde und ihre klinische Bedeutung in der Kinder- und Jugendpsychiatrie. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2004; 32:117-29. [PMID: 15181787 DOI: 10.1024/1422-4917.32.2.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Einleitung: Die Rolando-Epilepsie ist das häufigste Epilepsie-Syndrom im Kindesalter. Sie ist elektroenzephalographisch charakterisiert durch das Auftreten von fokalen epilepsietypischen Potentialen, den sog. Rolando-Spikes (benigne epilepsietypische Potentiale des Kindesalters, BEPK). BEPK treten mit einer Häufigkeit von etwa 1,5 bis 2,4% bei Kindern auf; nur ein Zehntel erleidet epileptische Anfälle. Methoden: Diese Arbeit gibt einen Überblick über genetische, epidemiologische, radiologische, neurophysiologische, metabolische und neuropsychologische Befunde bei Kindern mit BEPK. Resultate: Der epileptologische Verlauf ist günstig, eventuell auftretende Anfälle sistieren spätestens mit der Pubertät; die epilepsietypischen Potentiale sind dann nicht mehr nachweisbar. Entgegen früherer Annahmen erstreckt sich das Symptomenspektrum über seltene Anfälle hinaus auf neuropsychologische Beeinträchtigungen und Verhaltensauffälligkeiten, auch bei Kindern ohne manifeste Anfälle. Der Einfluss der Rolando-Spikes auf die Entwicklung betroffener Kinder und ihr Verhalten ist unklar. Durch zwei Modelle wird versucht, den Zusammenhang von paroxysmaler EEG-Aktivität und neuropsychologischen Auffälligkeiten zu erklären. Das erste betrachtet die beobachtbaren Defizite als vorübergehende kognitive Beeinträchtigung infolge der epileptischen Aktivität; das zweite sieht als Ursache eine genetisch bedingte zerebrale Reifungsstörung mit enger Verwandtschaft zu Teilleistungsstörungen. Schlussfolgerung: Die Behandlungsnotwendigkeit neuropsychiatrischer Symptome bei Kindern mit BEPK ohne manifeste Anfälle wird derzeit kontrovers diskutiert.
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Affiliation(s)
- M Holtmann
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt.
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Vadlamudi L, Harvey AS, Connellan MM, Milne RL, Hopper JL, Scheffer IE, Berkovic SF. Is benign rolandic epilepsy genetically determined? Ann Neurol 2004; 56:129-32. [PMID: 15236411 DOI: 10.1002/ana.20153] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Benign rolandic epilepsy (BRE) is considered to be a genetically determined idiopathic partial epilepsy. We studied twins with BRE and compared the concordance with a twin sample of idiopathic generalized epilepsy (IGE). All eight BRE pairs (six monozygous [MZ], two dizygous [DZ]) were discordant. MZ pairwise concordance was 0 (95% confidence interval [CI], 0-0.4) for BRE compared with 0.7 (95% CI, 0.5-0.9) for 26 IGE MZ pairs. Our data suggest that conventional genetic influences in BRE are considerably less than for IGE, and other mechanisms need to be explored.
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Affiliation(s)
- Lata Vadlamudi
- Epilepsy Research Centre, Department of Medicine (Neurology), University of Melbourne, Austin Health, Australia
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Abstract
PURPOSE Some children with rolandic epilepsy have associated neuropsychiatric deficits resembling symptoms of attention deficit-hyperactivity disorder (ADHD), the most common neurobehavioral disorder of childhood. The clinical overlap between both syndromes has received relatively little attention. The study examines the frequency of rolandic spikes in nonepileptic children with ADHD and compares it with a historic control group of 3,726 normal school-aged children. ADHD patients with and without discharges are compared regarding age at admission, sex, global functioning, and distribution of ADHD subtypes. METHODS The EEGs of 483 ADHD outpatients between 2 and 16 years meeting diagnostic criteria for ADHD according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were evaluated prospectively. If rolandic spikes were present, separate sleep EEGs were performed to exclude a bioelectrical status epilepticus during slow-wave sleep. RESULTS Rolandic spikes were detected in the EEGs of 27 children (5.6%; 22 boys and five girls). Seizure rate during follow-up tended to be larger in children with rolandic spikes. No significant differences were found between ADHD patients with and without spikes regarding sex and global functioning. ADHD children with rolandic spikes came to our attention significantly earlier than did children without discharges and tended to exhibit more hyperactive-impulsive symptoms, evidenced in a larger proportion of the diagnosis of ADHD combined type than ADHD inattentive type. CONCLUSIONS The frequency of rolandic spikes in children with ADHD is significantly higher than expected from epidemiologic studies. The question arises how ADHD symptoms are related to rolandic spikes in this ADHD subgroup. Possibly rolandic discharges or underlying, not fully understood mechanisms of epileptogenesis decrease the vulnerability threshold, advance the onset, or aggravate the course of ADHD.
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Affiliation(s)
- Martin Holtmann
- Central Institute of Mental Health, Department of Child and Adolescent Psychiatry and Psychotherapy, Mannheim, Germany.
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Boor S, Vucurevic G, Pfleiderer C, Stoeter P, Kutschke G, Boor R. EEG-related functional MRI in benign childhood epilepsy with centrotemporal spikes. Epilepsia 2003; 44:688-92. [PMID: 12752468 DOI: 10.1046/j.1528-1157.2003.27802.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The localization of epileptic foci is an important issue in children with extratemporal epilepsies. However, the value of noninvasive methods such as the EEG-assisted functional magnetic resonance imaging (fMRI) has not been sufficiently investigated in children. As a model of extratemporal epilepsies, we studied 7 patients aged 5 to 12 (median 10) years with benign childhood epilepsy and centrotemporal (rolandic) spikes. Interictal spikes were recorded during the fMRI acquisition on a MR-compatible battery-powered digital EEG system with 16 channels. The fMRI sequences were correlated off-line with the EEG spikes and analyzed with the software Statistical Parametrical Mapping SPM99. The fMRI results demonstrated the spike-related activation in the perisylvian central region in three patients; we could not demonstrate fMRI activation despite active spiking in 2 patients, and 2 patients did not produce sufficient spikes for fMRI analysis. We currently consider the spike-related fMRI as a research tool that localizes epileptic activity in selected patients. Further improvements of the technique are necessary to allow a clinical application of this method.
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Affiliation(s)
- Stephan Boor
- Institute for Neuroradiology, University Children's Hospital, Johannes-Gutenberg University, D-55101 Mainz, Germany.
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Abstract
The purpose of the study was to evaluate the incidence of a possible combination of rolandic and absence signs in epileptic children, which remains a subject of controversy. The medical files and electroencephalographic (EEG) records of children with rolandic, childhood absence, and juvenile absence epilepsy were retrospectively analyzed. During the antiepilepsy treatment, 6 of 66 patients with rolandic epilepsy, most of them with initial carbamazepine therapy, had absences and generalized spike-wave discharges of a secondarily generalized type. Five cases of 34 children with childhood absence epilepsy and 3 of 11 patients with juvenile absence epilepsy were identified with an EEG focus of the rolandic type. We considered the likely relation of absence features in rolandic epilepsy to the treatment or to an atypical course. The presence of a rolandic focus in absence epilepsies, however, makes the coincidence of these entirely distinct phenomena, even if very rare, not excluded. Further studies are required to elucidate a probable genetic or functional link between partial and primarily generalized EEG discharges in the idiopathic childhood epilepsies.
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Affiliation(s)
- Petia S Dimova
- Clinic of Child Neurology, University Hospital of Neurology and Psychiatry, Medical University, Sofia, Bulgaria.
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Doose H, Petersen B, Neubauer BA. Occipital sharp waves in idiopathic partial epilepsies--clinical and genetic aspects. Epilepsy Res 2002; 48:121-30. [PMID: 11823116 DOI: 10.1016/s0920-1211(01)00324-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In order to gain new insight into the pathogenesis and nosography of benign partial epilepsy with occipital paroxysms (BEOP) we retrospectively analysed cases with benign focal sharp waves (SHW) of different localisations, in which analogous EEG changes had been found in at least one first degree relative. Fifty-six families were evaluated. Nineteen cases with occipital SHW (group A) were compared with 37 cases without (group B). There was a broad spectrum of symptomatology with large overlaps between the two groups. However, a number of striking differences, yielding a characteristic picture of early childhood epilepsy with occipital foci were identified: (1) Age of onset under 5 years; (2) a larger proportion of febrile convulsions (FC 47 vs. 19%); (3) a trend towards a higher rate of typical early childhood occipital seizures (26 vs. 5%); (4) a higher rate of frontal and generalizing SHW foci (32 vs. 5%; 37 vs. 11%); (5) a higher rate of generalized spikes and waves (SW) (46 vs. 14%); (6) a trend towards a higher rate of photoparoxysmal response (PPR) (57 vs. 32%). The high prevalence of independent genetic traits favours a multifactorial pathogenesis. The predisposition to FC with characteristic early seizure onset and varying patterns of generalized genetic EEG traits plays a crucial role within the complex pathogenetic network. The early-onset benign childhood occipital seizure susceptibility syndrome of Panayiotopoulos (Benign Childhood Partial Seizures and Related Epileptic Syndromes, John Libbey & Company Ltd., London (1999)) cannot be regarded as the sole representative of occipital spikes in early childhood but as an important even though rare form of occipital epilepsy.
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Abstract
Epilepsy may be acquired or inherited. At least one half of epilepsy is genetic in origin; this figure is likely higher in children regardless of whether seizures are generalized or partial. Inherited epilepsies are classified as benign, cryptogenic, or symptomatic depending on associated clinical, electrographic, and neuroimaging features. To date, genetic mutations in the idiopathic inherited epilepsies affect channel function within the central nervous system; genes underlying symptomatic epilepsies are more heterogeneous. Accurate diagnosis of an inherited epilepsy syndrome provides useful prognostic information; it also may help guide diagnostic evaluation, including request for specific gene testing. In the near future, the relationship between genetic defect and response to specific anticonvulsants may also be better defined.
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Affiliation(s)
- L E Walsh
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis 46202, USA
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James WH. The hypothesized hormonal control of offspring sex ratio: evidence from families ascertained by schizophrenia and epilepsy. J Theor Biol 2000; 206:445-7. [PMID: 10988029 DOI: 10.1006/jtbi.2000.2145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Schizophrenic women reportedly have significant excesses of daughters. People with convulsions or seizures reportedly have excesses of brothers. And photosensitive probands reportedly have excesses of sisters. Steroid hormones affect neurotransmission in the brain. So these curious sex ratios are construed here as support for my hypothesis that parental hormone levels around the time of conception partially control the sexes of the resulting offspring.
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Affiliation(s)
- W H James
- The Galton Laboratory, University College London, Wolfson House, 4 Stephenson Way, London, NW1 2HE, U.K
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Affiliation(s)
- B A Neubauer
- Department of Neuropediatrics, University of Kiel, Germany
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Abstract
Clinical success with an antiepileptic drug (AED) depends primarily on its efficacy and tolerability. Clinicians also need to have a basic understanding of an AED's pharmacokinetic characteristics, particularly those affecting the potential for drug interactions such as hepatic enzyme inhibition or induction and protein-binding displacement. Successful treatment may be complicated by pharmacokinetic characteristics such as a short half-life, nonlinear kinetics, and active metabolites. Pharmacokinetic characteristics that make a drug easy to use may affect patient adherence. In general, newer AEDs such as topiramate (TPM) are simpler to use than traditional AEDs because they have more favorable pharmacokinetic characteristics and fewer drug interactions.
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Affiliation(s)
- W R Garnett
- Department of Pharmacy, School of Pharmacy, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond 23298-0533, USA
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Gelisse P, Genton P, Bureau M, Dravet C, Guerrini R, Viallat D, Roger J. Are there generalised spike waves and typical absences in benign rolandic epilepsy? Brain Dev 1999; 21:390-6. [PMID: 10487473 DOI: 10.1016/s0387-7604(99)00040-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Generalised 3 Hz spike wave (SW) discharges with or without absences have been described in children with benign epilepsy with centrotemporal spikes (BECTS), leading to speculations about a continuum between childhood absence epilepsy (CAE) and BECTS. We thus decided to evaluate the prevalence of absence seizures (AS) and generalised 3 Hz SW in patients with BECTS. All patients with BECTS first referred since 1986 have been identified prospectively. Their medical and electroencephalograph (EEG) records were analysed retrospectively, in the search for AS and generalised SW discharges. Over a period of 11 years, we found typical rolandic spikes in 66 newly referred patients; 64 had seizures typical for the condition (18 female, 46 male), two were asymptomatic and were not further analysed. All had routine waking EEG recordings, and 49 children (76%) had at least one sleep EEG. AS or classical generalised 3 Hz SW were never recorded from history or EEG data, respectively. However, 17 patients had some diffuse SW discharges, lasting 1-5 s, which appeared as grossly symmetrical in only seven children, with a clearly asymmetrical aspect in the others. Among these seven patients, the discharges were only seen on awakening in one, both during waking and nREM sleep stage I or II in one and only during nREM sleep stage I or II in five. They were apparently subclinical in all. We thus found neither AS nor classical 3 Hz SW discharges among 64 consecutive patients with BECTS. Brief bursts of bilateral abnormalities occur in about 25% of the cases, mostly with sleepiness. Such findings do not substantiate the existence of a continuum between CAE and BECTS.
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Affiliation(s)
- P Gelisse
- Centre Saint Paul, Marseilles, France.
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Musumeci SA, Hagerman RJ, Ferri R, Bosco P, Dalla Bernardina B, Tassinari CA, De Sarro GB, Elia M. Epilepsy and EEG findings in males with fragile X syndrome. Epilepsia 1999; 40:1092-9. [PMID: 10448821 DOI: 10.1111/j.1528-1157.1999.tb00824.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE AND METHODS One hundred and ninety-two fragile X male patients were investigated for seizures and EEG findings, 168 in a retrospective and 24 in another prospective study, to characterize the natural history of seizures, epilepsy, and EEG abnormalities in males with this syndrome. RESULTS Seizures were documented in 35 (18.2%) of 192 patients; they never started before the age of 2 years or after the age of 9 years. Seizures were frequently of the complex partial type and less frequently of the partial motor and generalized type. Seizures involving frontal and temporal lobes were commonly seen and were usually well controlled by anticonvulsants. In the majority of young fragile X patients studied, an age-related paroxysmal EEG pattern was found, which showed neurophysiologic characteristics very similar to those of the centrotemporal spikes. CONCLUSIONS These findings confirm that fragile X syndrome can be considered a genetic model of epilepsy.
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Affiliation(s)
- S A Musumeci
- Oasi Institute for Research on Mental Retardation and Brain Aging, Troina (EN), Italy
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Abstract
A 14-year-old girl had severe head trauma from a dog bite at the age of 9 days. This resulted in extensive brain damage, tetraplegia, mental retardation, and epilepsy. The seizures were of rolandic type, and the EEG showed multifocal sharp waves. The course was benign. The initial diagnosis of a pure symptomatic epilepsy was revised after demonstrating typical benign focal sharp waves in the EEG of the healthy sister. Thus a phenocopy of a benign partial epilepsy by the brain lesion could be excluded with sufficient certainty. This observation allows the conclusion that the genetic disposition underlying the sharp-wave trait characteristic of benign partial epilepsies can be involved also in the pathogenesis of seemingly pure symptomatic epilepsies. EEG studies on siblings of such patients are needed to exclude possible phenocopies.
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Affiliation(s)
- U Stephani
- Neuropediatric Department, University of Kiel, Germany
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Doose H, Tibow I, Castiglione E, Neubauer BA. Febrile convulsions with focal sharp waves: A subgroup of benign partial epilepsies of childhood with multifactorial etiology. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0896-6974(98)00043-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Benign epilepsy of childhood with centrotemporal spikes (BECT) is the most common partial epilepsy syndrome in the pediatric age group, with an onset between age 3 and 13 years. The typical presentation is a partial seizure with parasthesias and tonic or clonic activity of the lower face associated with drooling and dysarthria. Seizures commonly occur at night and may become secondarily generalized. They are usually infrequent and may not require antiepileptic drugs but, if treated, they tend to be easily controlled. Children with BECT are neurologically and cognitively normal. The EEG shows characteristic high-voltage sharp waves in the centrotemporal regions, which are activated with drowsiness and sleep. In this typical form, BECT is easily recognized. However, atypical cases are common and the definition of BECT can become blurred. Although further investigations are not required in cases with typical clinical and EEG findings and normal neurologic examinations, neuroimaging studies may be required in atypical cases to rule out other pathology. The long-term medical and psychosocial prognosis of BECT is excellent, with essentially all children entering long-term remission by mid-adolescence.
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Affiliation(s)
- E C Wirrell
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
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Millichap JG. Genetics of Epilepsies with Focal Sharp Waves. Pediatr Neurol Briefs 1997. [DOI: 10.15844/pedneurbriefs-11-7-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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